Predictors of liver failure in primary biliary cirrhosis

BACKGROUND: The disease progression of patients with primary biliary cirrhosis (PBC) varies significantly, and the prognostic markers that identify those patients who will develop liver failure have been scarcely studied from a Chinese cohort. AIMS: We aimed to determine the predictive factors of liver failure in patients with PBC. METHODS: Patients who were first diagnosed as PBC with hepatic compensation between January 2007 and December 2009 were enrolled in this cohort study. RESULTS: Altogether 398 patients were finally included. Of these patients, 80% were women, 98% had positive antimitochondrial antibodies, and 45% had positive antinuclear antibodies (ANA). To December 2012, a total of 38 patients developed liver failure. According to the outcome, patients who developed liver failure had had higher serum concentration of baseline total bilirubin (TBil) (p = 0.013) and total bile acid (TBA) (p < 0.001), and lower concentrations of baseline total cholesterol (Tch) (p = 0.008), than patients who did not develop liver failure. Additionally, the proportion of ANA positivity was statistically different between the two groups (p = 0.009). In the established model for predicting liver failure in PBC, three variables were finally selected out, including Tch (odds ratio (OR) 0.552, 95% confidence interval (CI) 0.394–0.774, p < 0.001), TBA (OR 1.006, 95% CI 1.002–1.010, p = 0.002), and ANA (+ versus –, OR 5.518, 95% CI 1.155–26.376, p = 0.032). CONCLUSIONS: ANA, Tch, and TBA are predictors of liver failure in PBC.